Abstract C004: End-of-life care in patients with advanced cancer in an urban safety net hospital

Abstract

Abstract Abstract End-of-life care (EoL) in patients with advanced cancer is uniquely challenging in an urban safety net hospital. Low socioeconomic status, poor health literacy and non-congruent language barriers are only a few of the possible challenges that patients can encounter. The purpose of this study was to understand patterns of EoL care for patients with advanced cancer treated at a racially diverse, urban academic safety net hospital. Experimental Procedures We performed a retrospective analysis of 308 adult patients with advanced cancer who died between 2012 and 2015. A standardized chart abstraction tool included sociodemographic, clincopathologic and health services variables. We defined under-utilization of EoL care as no enrollment in hospice or enrollment for three days or less. Aggressive EoL care was defined as 1) receipt of chemotherapy in the last 14 days of life, 2) admission to the intensive care unit in the last 30 days of life, 3) more than one admission (to the hospital or emergency department) in the last 30 days of life, or 4) dying in an acute care setting. Summary of Data Among 308 abstracted records, 54% were racial minorities, 63% were not born in the United States, 72% had public health insurance. In all, 48% of cases demonstrated under-utilization of EoL care, and 45% demonstrated aggressive EoL care. A multivariate analysis demonstrated that, after adjusting for other factors, every month of increased survival was associated with a 3% decreased risk of aggressive EoL care and of under-utilization of hospice. We also demonstrate that having a documented healthcare proxy and older age was also associated with utilization of EoL care. Conclusions In conclusion, appropriate EoL care is critical for all advanced cancer patients and can be improved for patients seeking care at safety net hospitals. Our study demonstrates that advanced age, having a healthcare proxy, and longer survival from a cancer diagnosis was associated with improved EoL care. These findings can help to inform targeted interventions to improve EoL care for diverse populations. Citation Format: Vina P Nguyen, Kate Festa, Minda Gowarty, Shabatun Islam, Gregory J Patts, Naomi Y Ko. End-of-life care in patients with advanced cancer in an urban safety net hospital [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C004.